Objective: To understand the vaccination coverage and associated factors among children under 7 years old in rural areas of Ningxia in 2019, so as to provide a basis for better immunization plans and corresponding strategies in this region. Methods: A multi-stage stratified cluster random sampling method was adopted to select 1 144 children under 7 years old and their families in three rural counties of Ningxia. Demographic information, as well as primary and secondary immunization was investigated. Multivariate Logistic regression analysis was conducted on the relevant factors. Results: In Ningxia, the coverage rate of primary vaccines for children under 7 years of age for hepatitis B vaccine, BCG vaccine and dpt vaccine was above 95%, polio vaccine 83.7%, measles vaccine 38.6%, "five vaccines" 33.8%, and the coverage rate of secondary vaccines was only 4.9%. There were statistically significant differences in the total vaccination rates of "five seedlings" in different ages, per capita annual income of different families, and whether they had received a health examination in the past year (χ2=33.60,13.17,29.96,P<0.05). There were statistically significant differences in the vaccination rates of secondary vaccines among different age groups, different inoculation units and whether received a physical examination in the last year (χ2=18.58, 8.45, 60.04, P<0.05). Multivariate analysis showed that the age of children and whether received physical examination in the last year were the relevant factors affecting the total inoculation of five seedlings(P<0.05). Age of children and inoculation unit were the relevant influencing factors affecting the secondary immunization(P<0.05). Conclusion The primary vaccination rate for children under the age of 7 in rural areas of Ningxia is kept at a high level, but the secondary vaccination rate is relatively low. It is suggested to strengthen publicity and education and establish effective mechanisms to improve the vaccination rate and protect the health of children in rural areas.